Right for Replacement

Years of rolling his foot while playing basketball, football and Ultimate Frisbee finally caught up with Craig Homenko Rockville, Md. When he was 50, X-rays showed that the cartilage in his left ankle was nearly gone, causing excruciating pain.

When medications and braces no longer offered relief, Craig decided he could either stew about it from a chair or have surgery.

Like Ward, because Craig was relatively young and active, he wasn’t considered to be a good candidate for ankle replacement. Active people are usually counseled against replacement, because higher levels of activity are thought to wear out replacement joints more quickly.

At 250 pounds, his weight was also a strike against him. More weight puts more stress on artificial joints, leading to early failures.

But being an active dad was important to Craig, and he knew an ankle fusion would put him on the sidelines for a lot of favorite family pursuits.

After researching the five different artificial ankles on the market, four two-component models (Agility, Eclipse, IN-BONE and Talaris), and a newer three-component system (STAR), Craig chose the most durable of the two-component designs.

All promise better functional results than ankle fusions, and at least in this respect, studies show that they deliver.

But when durability is a concern, an ankle replacement may not be the right option. A 2010 study of ankle replacements in Finland over more than 20 years found that nearly one in five replacements failed within five years, usually because of loosening of the components or instability.

Newer designs may be more durable.

 “We think they will last longer than in the past, but it’s too soon early to tell,” says Charles L. Saltzman, MD, Chairman of the Department of Orthopaedic Surgery at the University of Utah in Salt Lake City.

Although Craig knows he’ll probably have to have surgery again when the components wear out, he’s pleased with his choice.

 “There’s some soreness, which I was told will last a year,” says Homenko, who had surgery more than six months ago. “But it’s not the pain I had before. It’s great to be able to jog again.”